Heroin-assisted treatment in the Netherlands: History, findings, and international context

Blanken, Peter; Brink, Wim van den; Hendriks, Vincent M.; Huijsman, Ineke A.; Klous, Marjolein G.; Rook, Elisabeth J.; Wakelin, Jennifer S.; Barendrecht, Cas; Beijnen, Jos H.; Ree, Jan M. van

doi:10.1016/s0924-977x(10)70001-8

Cited by 58 publications

(63 citation statements)

References 122 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…174, D-45147 Essen, Germany; Tel/Fax: 49 (0) 201 7227 180/254; E-mail: norbert.scherbaum@uni-due.de no generally accepted definition of a critical threshold of severity of opiate addiction up to now. According to the discussion on the goals of heroin prescription [2,3], important aspects for the identification of a severely ill opiate addict are comorbid somatic diseases (e.g. AIDS, hepatitis B and C), comorbid mental disorders (e.g.…”

Section: Introductionmentioning

confidence: 99%

“…According to randomized controlled studies from Canada [4], Germany [5], the Netherlands [6], Spain [7], Switzerland [8], and the United Kingdom [9; see also review: [2]), heroin prescription is more successful than methadone maintenance treatment for severely ill opiate addicts. Success in these studies is defined taking into account complex outcome criteria covering especially drug consumption and physical health.…”

Section: Introductionmentioning

confidence: 99%

“…Success in these studies is defined taking into account complex outcome criteria covering especially drug consumption and physical health. HP is also associated with slightly more medication-related serious adverse effects of medication such as overdose or seizures than methadone maintenance treatment [2].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Opiate Addicts` Attitudes Towards Heroin Prescription~!2009-07-31~!2010-05-28~!2010-07-14~!

Scherbaum¹,

Rist²

2010

TOADDJ

View full text Add to dashboard Cite

Introduction:The competence of opiate addicts to give a valid consent to heroin prescription (HP) has been doubted in principle under the assumption that the pathological urge to use heroin would prevent them from reasonably weighing the pros and cons of HP. This study was done to test whether opiate addicts have a differentiated attitude towards HP which would be a basis for an individual decision to take part in HP.Methods: Opiate addicts were asked to voluntarily and anonymously fill out a questionnaire containing 18 statements pro or contra HP at various health care facilities. There was one question about their willingness to participate in HP.Results: 277 questionnaires were analyzed (methadone maintenance clinics [MMT] 44%, counseling offices 30%, lowthreshold institutions 26%). 56% of all clients wanted to take part in HP. 56% of the clients currently in MMT, but only 20% of the clients in the low threshold services rejected HP. Those who declined saw their chance to achieve abstinence reduced in HP compared to MMT. Patients who accepted endorsed statements such as not being able to abstain from the heroin "kick". Four of these statements predicted the HP decision in a binary logistic regression model, yielding a rate of 78% correct classifications.Discussion: The attitudes of opiate addicts towards HP cannot be reduced to unanimous and inconsiderate acceptance of HP, as rejections are frequent. Attitudes towards HP appear to be based on an individual evaluation of pros and cons, therefore, the consent of opiate addicts to HP should not be considered generally invalid.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Opiate Addicts` Attitudes Towards Heroin Prescription~!2009-07-31~!2010-05-28~!2010-07-14~!

Scherbaum¹,

Rist²

2010

TOADDJ

View full text Add to dashboard Cite

show abstract

“…DBS would only be used to treat addicted people who failed existing treatments (such as MMT and buprenorphine). Given this, the more appropriate comparator would be heroin maintenance treatment, which has been trialled with positive results in patients who have failed at MMT, and found to be more cost-effective than MMT in this patient population [7,8].Many of these points are acknowledged in the discussion, but these caveats are not reflected in the abstract, which means that the results seem to support a stronger claim than we believe they warrant. …”

mentioning

confidence: 99%

mentioning

confidence: 99%

Is Deep Brain Stimulation for Addiction an Acceptable Crime Control Measure?

Hall¹,

Carter²

2012

Addiction

View full text Add to dashboard Cite

We wish to comment on Stephen et al. 's argument that trials of deep brain stimulation (DBS) are warranted in heroin addiction, because DBS needs only to be 49% as effective as methadone maintenance treatment (MMT) for it to be a cost-effective intervention [1]. We accept that threshold analyses can be informative in specifying the characteristics required for cost-effectiveness of interventions, but we have some major concerns with the way in which their analyses were performed and the conclusions drawn.First, the analysis is biased in favour of DBS because it compares the average performance of MMT, a treatment that is often implemented indifferently, with evidence on the effectiveness of DBS in Parkinson's disease (PD) reported in clinical trials conducted in academic research settings by well-resourced research groups. MMT is often provided in ways that undermine its effectiveness significantly (e.g. by using inadequate doses of methadone to prevent drug cravings) or responding punitively to positive urines (e.g. by dose reductions or expulsion from treatment) [2]. Lintzeris showed that many treatment refractory heroin-dependent individuals will respond to MMT if it is provided appropriately [3]. History also suggests that the average effectiveness of DBS is likely to be poorer when used routinely in less than optimal conditions with less intensive psychosocial support [4].Secondly, we doubt that good results of DBS in PD will apply to heroin-addicted individuals. PD patients are not ambivalent about controlling their movement disorders in the way that heroin-addicted individuals are about their heroin use. Heroin-addicted individuals are adept at subverting the effects of methadone and naltrexone, so we would expect them to find ways of modulating stimulation parameters to allow drug use (e.g. by misreporting craving when stimulation parameters are adjusted). This may have happened in a recent case report of DBS in a heroin-addicted patient who succeeded in using heroin for 2 weeks after undergoing DBS [5].Thirdly, the costs of untreated heroin addiction that were used in the threshold analysis all come from the United States, where criminal justice costs comprise 57% of the total costs. By using these cost data, DBS is being advocated implicitly as a crime control measure. An ethical review of the use of psychosurgery for the treatment of psychiatric disorders recommended strongly that it should not be used for social control ([6], p. 58).Fourthly, we do not believe that MMT is the appropriate comparator in their threshold modelling. DBS would only be used to treat addicted people who failed existing treatments (such as MMT and buprenorphine). Given this, the more appropriate comparator would be heroin maintenance treatment, which has been trialled with positive results in patients who have failed at MMT, and found to be more cost-effective than MMT in this patient population [7,8].Many of these points are acknowledged in the discussion, but these caveats are not reflected in the abstract, which means that...

show abstract

Psychiatric Comorbidity in Heroin Maintenance and Methadone Maintenance Treatments

Uchtenhagen

2014

Co-Occurring Addictive and Psychiatric Disorders

View full text Add to dashboard Cite

Heroin-assisted treatment in the Netherlands: History, findings, and international context

Cited by 58 publications

References 122 publications

Opiate Addicts` Attitudes Towards Heroin Prescription~!2009-07-31~!2010-05-28~!2010-07-14~!

Opiate Addicts` Attitudes Towards Heroin Prescription~!2009-07-31~!2010-05-28~!2010-07-14~!

Is Deep Brain Stimulation for Addiction an Acceptable Crime Control Measure?

Psychiatric Comorbidity in Heroin Maintenance and Methadone Maintenance Treatments

Contact Info

Product

Resources

About